To bring the coronavirus pandemic under control, President Joe Biden has challenged all Americans to mask up for 100 days and issued an executive order requiring masks on federal property and on planes.
These measures will help establish a new national norm of mask-wearing—a simple, commonsense act to promote public safety. If we began today, universal mask use could save more than 37,000 lives in the United States by March 1, the Institute for Health Metrics and Evaluation estimates.
All masks, however, are not created equal. And as more virulent variants of the coronavirus become more prevalent, the quality of masks is becoming as important as their consistent use. Some experts are now calling for everyone to wear the high-quality N95 masks used by health care workers, though they are still in short supply, while others are urging people to wear two masks instead of one.
There’s a better step the Biden Administration can take: Help establish voluntary industry standards—blessed by the federal government—for mask quality and effectiveness. Such guidelines would help maximize the benefits of mask use by raising the bar for manufacturers and standardizing production, helping consumers choose the best options for everyday protection, and reinforcing the message that masks work. Mask manufacturers have, in fact, already recognized the utility of industry-wide standards and have reportedly been working for months to establish them, as The Washington Post reported in October. But as the Post also reported, these efforts have been hamstrung by industry infighting and by the lack of a federal imprimatur on the initiative—unsurprising given the Trump administration’s lax attitude toward masks.
President Biden should step in now to jumpstart these efforts and move quickly to help the industry establish uniform standards for the production, testing, and labeling of masks while the crisis is at its peak. Ultimately, the goal should be a federal mask standard regulating the quality of mass-produced masks for the general public. While universal masking can help reduce the spread of infections, broader access to higher-quality masks and better consumer information could help end the pandemic that much more quickly.
Mask Confusion Now Reigns
By now, most Americans are aware of N95 masks, so called because they filter out at least 95 percent of airborne particles. These masks have served as the primary defense against COVID-19 for front-line health care workers, and their production is tightly regulated by the federal government. The government defines the standard for N95 masks, tests masks for compliance, and publishes a list of approved manufacturers. A similar, but less rigorous procedure, applies to the manufacture of surgical masks, which the Food and Drug Administration considers a “medical device.”
Because of N95 supply shortages, however, the Centers for Disease Control (CDC) still recommends that the general public rely on “cloth” masks. While the CDC broadly advises that these masks be made of “two or three layers” of “tightly woven fabric,” consumers have no specific guidance for navigating the now dizzying array of masks available online and from retailers, many of which seem more about style than about preventing coronavirus. The result for many Americans has been mass mask confusion.
My household supply of masks, for example, includes everything from disposable blue masks bought in bulk from Costco to cheap cotton masks from Old Navy, thicker masks made from “quilters cotton,” “breathable” nylon and polyester masks with filter pockets, and two never-worn silk masks from Amazon that are uncomfortably similar to lingerie. While any of these is likely better than the bandana held together by hair scrunchies I relied on in the pandemic’s early days, I have no idea which of these is the most effective, especially since manufacturers have been scrupulous in their disclaimers to avoid liability.
Compounding the uncertainty is an emerging body of research showing that the effectiveness of cloth masks can vary widely, depending on the materials used.
One recent study analyzed 44 different materials for their “filtration efficiency”— i.e., their effectiveness in blocking the kind of aerosol particles that could potentially transmit COVID-19. In addition to surgical masks, the researchers looked at a wide array of household materials used in manufactured and DIY masks, including vacuum bags, coffee filters, cotton, silk, synthetics such as nylon and polyester and even fabrics such as velour and flannel. What they found was that some materials are close to useless (polyurethane foam, for instance, blocks less than 10 percent of particles) while others were highly efficient (vacuum bags beat out surgical masks, though they are also impossible to breathe through). Other studies have found that 100 percent cotton masks can filter out somewhere between 40 percent and 60 percent of airborne particles, compared to about 80 percent for surgical masks.
Why Better Masks Matter
Federally-supported industry standards can cut through the current confusion by establishing minimum thresholds for manufacturing quality and boosting consumer confidence in the masks people buy. Such a standard could also be effective without the kind of rigorous testing and approval process now required for N95s.
Here’s one possibility for how the Biden Administration could make this happen. First, the White House should immediately convene a task force of leading manufacturers and materials science and public health experts and set a tight deadline for the establishment of draft quality and labeling standards. Second, the FDA and CDC should review and comment on this draft framework but ultimately allow the initiative to be industry-led. Participation would be voluntary, and manufacturers would be allowed to designate a reputable third-party organization to certify that its masks meet the mark, akin to the way that Underwriters Laboratories now certifies appliances for safety. Alternatively, manufacturers can pay the government a user fee to test and certify their masks (roughly in the same way that pharmaceutical companies currently pay user fees to the FDA as part of the approval process for new drugs). Eventually, the government should formally promulgate federal standards for mask quality.
The result would be something like nutritional labeling for masks—consumers can be assured that a particular brand of mask is guaranteed to have a certain level of filtration efficiency and is made to fit without the gaps and leaks that also bedevil poor-quality masks. Lesser-quality masks would stay on the market, but their manufacturers could not make claims about their effectiveness or to advertise their products as having passed muster, in the same way that grocery manufacturers can’t haphazardly label their products “organic” or “fat-free.” Enforcement would fall to the Federal Trade Commission, as it does with all deceptive advertising.
A voluntary mask standard—especially if it carries a federal stamp of approval—would likely raise the overall quality of the masks available in the market. Given the new, more contagious variants of the coronavirus now circulating, many more consumers will be interested in high-quality masks comparable or nearly-equivalent to N95s. The new UK strain, for instance, is estimated to be about 50 percent more infectious, meaning that it takes many fewer particles to make someone sick. The difference between a mask that filters out 40 percent of particles and one that filters out 60 percent of particles could determine if someone becomes infected or can infect others.
Mask standards would also help rid the market of counterfeit and substandard masks by helping consumers identify and create demand for certified high-quality masks. Manufacturers of higher-quality masks will also benefit, because they can ensure their products stand out in a crowded marketplace. As things currently stand, many consumers unsure of the quality of cloth masks might be buying what they believe to be higher-quality N95 or KN95 masks online. But as The Wall Street Journal reported earlier this year, many of these masks are subpar, with some imported “KN95” masks testing at filtration efficiencies of as low as 15 percent.
A final benefit of mask standards is to provide concrete evidence of how masks work to stop the spread of COVID-19, which could help battle persistent misinformation and encourage compliance among lax maskers. Certifying masks for quality can signal to the public their effectiveness and bolster even further the already voluminous science on their efficacy. Done right, these efforts could even work to help depoliticize mask-wearing, particularly if trusted manufacturers—not just the government—are staking their credibility and reputations on their products. In fact, any effort to establish mask quality standards should initially be led by industry, rather than accomplished by government fiat. Aside from the fact that regulatory processes will take more time than we can currently afford, top-down federal standards could be perceived as yet another polarizing government mandate. Industry-led standards, on the other hand, could be framed more neutrally, as a boon to consumer protection.
In an ideal world, N95 masks become universally available to Americans, in the same way that Korean citizens have broad access to KF94 masks (Korea’s equivalent of the N95) since early in the pandemic. This could yet happen. Among his first acts in office, Biden invoked the Defense Production Act to ramp up production of masks and other protective equipment. In the meantime, kickstarting the establishment of national mask standards can help ensure that the masks currently available to the general public offer the best possible protection. With the darkest months of the pandemic still potentially ahead of us, we need the best tools we can get.